Sewer Tap Request Form 680 Mayport Rd 2012 CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
'= 1200 Sandpiper Lane
ATLANTIC BEACH,FL 32233
1 (904) 270-2535 or(904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 5/23/12 Project Address: 680 Mayport Rd.
No. of Units: 1 Commercial X Residential Multi-Family
New Water Tap(s) & Meter(s) Meter Size(s)
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer 1
Name: Assembly of God Church
Applicant Address: 680 Mayport Rd.
City: State: Zip:
Phone Number: 249-5511 Cell Number:
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
SDC Fees Pd. —They are already on
Water System Development Charge $ City sewer, but a couple of their
Sewer System Development Charge $ N/A bathrooms still had a septic tank. They
Water Meter Only $ are having them tied in to the other
Water Meter Tap $ section that is served by City sewer
Sewer Tap $ N/A and eliminate the septic tank.
Cross Connection $
Other (Plumber) $
TOTAL $
APPROVED: Donna Kaluzniak 5/23/12
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
White, Debbie
From: Ramsay, Debra
Sent: Thursday, May 24, 2012 8:28 AM
To: White, Debbie; Graham Shirley; Griffin, Michael
Subject: FW: Septic to Sewer
Attachments: 680 Mayport WS Form.docx; Septic to Sewer FAQs.pdf
FYI
Thanks,
Debbie
From: Kaluzniak, Donna
Sent: Wednesday, May 23, 2012 4:59 PM
To: church(-Olttb.org
Cc: Ramsay, Debra; Walker, Chris
Subject: Septic to Sewer
Selina,
Per our conversation this afternoon, I have attached the Water/Sewer tap form and am sending it to Debbie Ramsay.
Because the church is already on City sewer and this project eliminates a septic tank that is serving a small part of the
building,there are no additional system development charges, and the only costs financed will be those of your private
contractor.
I've attached some Frequently Asked Questions as well.
If you have any more questions,feel free to call. (Hope I spelled your name correctly)—thanks, Donna
Donna Kaluzniak
Utility Director
City of Atlantic Beach
902 Assisi Lane
Atlantic Beach, FL 32233
PH 904-270-2535
FAX. 904-242-3475
dkaluzniak(acoab.us
Please note: Florida has a very broad public records law. Most written communications to or from city officials
regarding city business are public records available to the public and media upon request. Your e-mail communications
may be subject to public disclosure.
CITY OF ATLANTIC BEACH, FLORIDA
VOLUNTARY ASSESSMENT AGREEMENT
PROPERTY DESCRIPTION:
OWNER: Atlantic Beach Assembly of God
680 Mayport Road
Atlantic Beach, Florida 32233 PAID
PROPERTY ADDRESS: 680 Mayport Road JAN 0 3 2013 -
RE 4, 170747-0000 Cid # / �� /
LEGAL DESCRIPTION: 18-034 38-2S-29E, Atlantic Beach Sec H
Lots 1 to 7 (EX R/W) Block 35
O/R BKS 6497-1161, 1162, 1163
This document shall serve as an extended payment agreement between you and the City of
Atlantic Beach, Florida for the above listed total amount and for which said amount will be filed
as a lien with the Court of the Circuit Court for Duval County, Florida until the entire balance is
paid.
CHARGES: System Development Charge$1,250.00
Contractor 7,330.00
Filing Fees 35.50
TOTAL CHARGES FINANCED: $8,615.50
TOTAL INTEREST MOVER LOAN TERM: $1.851.83
TOTAL AMOUNT OF AGREEMENT/LIEN: $10,467.33
TERMS: Number of Monthly Payments 120
Due Date Due monthly with your utility bill
Billing Included on utility bill
Late Charges 10%
Failure to pay all charges will result in the water services being cut-off.
Payment Amount $87.23 per month
Total Interest over term of loan $1,851.83
Interest Rate 4.00%
LIEN: A lien in the amount of the TOTAL AGREEMENT above shall be executed and
recorded against the above >eferencedproUerties. The owner hereby agrees to pay all
recording fees and costs involved with the execution of the lien. Upon payment being
made in full, the lien shall be released of record.
Page l of 2 AB Assembly of God Agreement
Please indicate your acceptance of tl:'e provisions of this agreement by signing in the place
indicated. Your signature signifies y1our agreement to indemnify and hold harmless the City of
Atlantic Beach, PL, from any and all damages resulting from your failure to timely make the
above payments, including reasonable attorney's fees and court costs.
Property Owner
/�� Date:
By: /,�"G
Atlan each As§embly of God
Past r Donnie Hutto
City of Atlantic Beach
By � — Date: jO 4 z
Jim Hson, City Manager
Page 2 of 2 AB Assembly of God Agreement
CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
+ -x 1200 Sandpiper Lane
ATLANTIC BEACH,FL 32233
(904) 270-2535 or (904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 11/26/12 Project Address: 680 MUport Road
No. of Units: 1 Commercial (Church) Residential Multi-Family
New Water Tap(s) &Meter(s) Meter Size(s)
New Irrigation Meter Upgrade'Existing Meter from to (size)
New Connection to City Sewer 1
Name: Pastor Donnie Hutto
Applicant Address: _680 Mayport Rd
City: Atlantic Beach State: FL Zip: 32233
Phone Number: 249-5511 Cell Number:
Email Address pastor(a-,lttb.org Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
Church expansion was built in
Water System Development Charge $ 1999/2000 and the addition was
Sewer System Development Charge $ 11,250 connected to sewer. No impact fee
Water Meter Only $ was paid—charging the fee at the rate
Water Meter Tap $ in 2000.
Sewer Tap $
Cross Connection $ The older section of the church is
Other—Harry L. Hayes Plumbing $ 7,330 connected to septic tank. They have
quote from plumber to connect that
TOTAL $ 8,580 portion with the newer section into the
sewer system.
APPROVED: Donna Kaluzniak
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
HARRY,L.HAYES PLUMBING,INC.
an A14 UW 6837 Oakwood Drive
PLUMBING, INC
-
Jacksonville,FL 32211 - - --
— --
License CFC-1427058
PHONE(904)723-5609 FAX(904)329-4325
PROPOSAL SUBMITTED TO: DATE:10-20-2011
j NAME -Adiritic Bch.Assembly of-God
AM: Pastor Hutto
i;ADDRESS -68O Mayport Road
Atlantic Beach;Florida 32223
--- --- ------
' PHONE
i:7 Ii
PROJECT:Sewer Connection/Septic Abandonment
- - -- - ----- -- - - - -- - - -- -
ITEM.4 DESCRIPTION
----- ------- --- - COST
1 Installation of 4"PVC Sewer Line from south front corner around front north side $5580.00
for connection to church sewer lateral.With-Out Asphalt Cutting and Repairs.
tg andepai .' 0'X2' $1750.002 AsphaltCu
3 Permits (Plumbing and Septic Abandonment)Included.
Excludes Irrigation,Electrical,tandscapingRepairs. **********
* Excludes City Impact Fees. **********
Complete Project Total »»» $7330.00
Please contact us with any questions or comments.
Thank you for your business!
REORDER 905•U.S.PATENT NO.5538290,5575508,5641183,5785353,5984364,6030000
�S CITY OF ATLANTIC BEACH
v� 800 SEMINOLE ROAD
' A'I'I_,ANTIC BEACH,FLORIDA 32233-4445
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD NO. 108317
ATLANTIC BEACH,FLORIDA 32233-4445
INVOICE INVOICE PURCHASE PRf1JECT ACCOUNT
AMOUNT
NUMBER DATE O DER NO. NUIIIBER NUMBER
RE#170747-0000 12/26/2012 410-5506-535.34-07 1,250.00
GROSS RETAINAGV, DISCOUNT NET
$******1, 250 . 00 $******1,250.00
PREPARED 1/07/13 , 11 : 05 : 15 PAYMENTS DUE RECEIPT
CITY OF ATLANTIC BEACH PROGRAM BP820L
-------------------------------------------------
APPLICATION NUMBER: 13-0000120,0 680 MAYPORT RD
FEE DESCRIPTION AMOUNT DUE
---------------------------------------------------------------------------
SEWER SDC—SYSTEM DEV CHG 1250 . 00
TOTAL DUE 1250 . 00
Please present this receipt to the cashier with full payment .
Cit of Atlantic Beach
*** CUSTOMER RECEIPT ***
Dper: BASHLEYType: DC Drawer: 1
Date: pp1/07/13 00 Receipt no: 25095
Descriion 1QQuantity Amount
2 13BP ]WILDING PERMITS
1.00 $1250.
Tender detail.
CK CHECK 168317 $1256.00
Total tendered $1250.00
Total payment' $1250.00
Trans date: 1/07/13 Time: 11:07:06